Journal Article

A shift in the Th<sub>1</sub>/Th<sub>2</sub> ratio accompanies the clinical remission of systemic lupus erythematosus in patients with end‐stage renal disease

Gunnar Heine, Urban Sester, Martina Sester, Jürgen E. Scherberich, Matthias Girndt and Hans Köhler

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 17, issue 10, pages 1790-1794
Published in print October 2002 | ISSN: 0931-0509
Published online October 2002 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/17.10.1790
A shift in the Th1/Th2 ratio accompanies the clinical remission of systemic lupus erythematosus in patients with end‐stage renal disease

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Background. Patients suffering from systemic lupus erythematosus (SLE) with renal involvement often show remission of systemic clinical activity after progression to end‐stage renal disease (ESRD). SLE is characterized by predominantly humoral, T‐helper (Th)2‐mediated autoimmune responses. Since ESRD induces a state of immunodeficiency that affects the balance of Th cell subsets, we hypothesized that a Th1 shift induced by ESRD leads to clinical remission of SLE.

Methods. Using single‐cell measurement of intracellular cytokines by flow cytometry after polyclonal stimulation with PMA/ionomycin, helper cell profiles were analysed in SLE patients with preserved renal function and in SLE patients with ESRD, from both isolated peripheral blood mononuclear cells (PBMC) and whole blood.

Results. Using the whole‐blood assay, patients with SLE and preserved renal function showed a predominance of Th2 cells compared to healthy controls (patients, Th1/Th2 ratio 6.0±1.0 vs controls, 9.0±1.0; P<0.05). In contrast, SLE patients with ESRD have significantly more Th1 cells (36.8±5.0%) than those without ESRD (23.4±3.6%; P<0.05). This results in an enhancement of the Th1/Th2 ratio to 12.1±2.6, which is not significantly different from healthy controls. These data were confirmed using a PBMC‐based assay.

Conclusions. SLE patients with preserved renal function show a bias in the differentiation of Th cells towards Th2. Once ESRD occurs, the Th1/Th2 ratio normalizes. This may contribute to the remission of Th2‐mediated autoimmune diseases such as SLE.

Keywords: flow cytometry; haemodialysis; immunodeficiency; PBMC; systemic lupus erythematosus; Th1/Th2

Journal Article.  2871 words.  Illustrated.

Subjects: Nephrology

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